Mental health and HIV: A tale of two integrations

Issue: With the advent of antiretroviral therapy on a global scale, many people living with HIV/AIDS (PLHIV) can and do lead normal and active lives for many years. However, many suffer from undetected and untreated mental health (MH) problems which can have a profound effect on quality of life, ART adherence and progression of disease. Project description: To address the information gap in MH services for PLHIV, AIDSTAR-One prepared a technical brief and two case studies to document innovative, successful approaches to integrating MH and HIV services in high risk groups. The first case study was conducted with the Family Health International program in Vietnam in which MH services were integrated into methadone and HIV treatment programs for HIV positive injecting drug users (IDUs). The second case study involved the Peter C Alderman Foundation Psychotrauma Clinics where MH providers integrated HIV services, linkages and referrals into their care plan for traumatized clients in Northern Uganda. In-country visits included interviews and focus groups with key stakeholders, program staff, clients, ministries of health and other implementing partners. Lessons learned from both programs include the importance of: (1) starting small with pilot interventions, (2) building on existing systems and referral networks, (3) using data to inform practice and maintain quality assurance, and (4) building in-country capacity and ownership for sustainability. Recommendations are for a step-wise approach to building systems to integrate MH and HIV services within a Continuum-of-Care Model to provide comprehensive care and support for PLHIV in low and middle-income countries.